Inspection on 10/04/07 for Winsford Grange Care Home

This inspection was carried out on 10th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Winsford Grange Care Home 27/10/08

Winsford Grange Care Home 15/04/08

Winsford Grange Care Home 29/06/06

Winsford Grange Care Home 22/09/05

Winsford Grange Care Home 27/04/05

Winsford Grange Care Home 14/10/04

Winsford Grange Care Home 17/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Winsford Grange Care Home Station Road Bypass Winsford Cheshire CW7 3NG Lead Inspector Denis Coffey Unannounced Inspection 10th April 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000018743.V332299.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000018743.V332299.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Winsford Grange Care Home Address Station Road Bypass Winsford Cheshire CW7 3NG Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01606 861771 01606 861705 www.c-i-c.co.uk. Community Integrated Care Mark Laight Care Home 60 Category(ies) of Dementia (3), Dementia - over 65 years of age registration, with number (30), Old age, not falling within any other of places category (30), Physical disability (5) DS0000018743.V332299.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 60 service users to include: * Up to 30 service users in the category of OP (old age not falling within any other category * Up to 30 service users in the category of DE(E) (dementia over the age of 65) * Up to 3 service users age 60 years upwards in the categories of PD or DE * 2 named service users under the age of 65 in the category of PD 29th June 2006 Date of last inspection Brief Description of the Service: Winsford Grange is a purpose built care home. It has two units: one for elderly frail residents and one for older people with dementia. Each unit has two wings with 15 beds. Dickens and Austen are the wings for the elderly frail residents whilst Bronte and Chaucer are the wings used for people with dementia. The home is a single storey building with good access for wheelchairs. There are 38 single bedrooms and one double room. None of the bedrooms has ensuite toilet or bathroom facilities. The home has private enclosed gardens. It has good car parking facilities, is on a local bus route, and is close to rail services. Registered nurses are on duty at the home at all times in accordance with statutory requirements. The fees range from £390 to £520 per week. Additional charges are made for hairdressing and aromatherapy. Further information can be obtained from the manager of the home. DS0000018743.V332299.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit to the home was part of its key inspection and was carried out on 10 and 11 April 2007 by one inspector. The key inspection of the home considered events that have occurred at the home since its last inspection. During the visit to the home, the inspector toured the building, looked at care and general records, spoke with staff and people who live at the home. People who live at the home gave their views of how it runs; their comments are included in the report. What the service does well: The home carries out assessments with people who are thinking of moving in to find out about their needs/strengths in relation to the activities of daily life. Staff were seen to have positive, supportive and friendly relationships with the people living at the home so that they felt comfortable with the care the staff provide. A wide and varied programme of activities is available that takes place both within and outside of the home to keep the residents active and stimulated. People living at the home said they enjoyed the activities and could choose whether to take part in them or not. The food provided at the home is good quality with choice available at all meals so that people living there have a varied diet that they enjoy. Furnishings and décor have been well maintained, and there is a choice of spaces for people to spend time in on all of the four units. People are able to personalise their own bedrooms so that they live in comfortable, clean and homely surroundings. Staff working at the home have the chance to do training to improve their skills so they can provide the best quality care for the people who live at the home. The home is well managed and people spoken with said that the manager is always available to listen to what they think so their views are taken into account in the way the home is run. DS0000018743.V332299.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000018743.V332299.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000018743.V332299.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2&3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People moving into the home are given information about the home and have their needs assessed so they will know if their needs can be met there. EVIDENCE: Records showed that people whose care was being paid for by a local authority had a copy of the contract between the home and the local authority and had a ‘residential care agreement’ from the company that owns the home. This agreement specified the services covered by the weekly fee, the person’s responsibilities, information as to how to make their concerns known, and the periods of notice required to terminate the agreement. People who were paying for their own care had been given the same information together with a statement outlining the weekly fee for living at the home. DS0000018743.V332299.R01.S.doc Version 5.2 Page 9 The care records for two people who had recently moved into the home were checked during this inspection visit. Both contained an assessment of need that had been carried out by Cheshire Social Services and an assessment done by a nurse from the home that was based on the person’s needs/abilities in meeting their activities of daily living. The home does not have any intermediate care beds so Standard 6 does not apply. DS0000018743.V332299.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The needs of people living at the home are identified in their care records. However, recording needs to be improved to show what needs to be done to meet all their health care needs. EVIDENCE: The company that runs the home has recently introduced new care records for use with people living at the home. The records of three people were checked during the inspection visit. Two contained a range of care plans that identified the specific needs/problems of the person and what the staff should do to meet those needs. Both records contained a social history of the person that included information on their working and family life, and their hobbies and interests. Risk assessments were in place for such things as safe moving and handling, and skin care. The daily records for one person showed they had back pain and the staff had called the doctor to check this. DS0000018743.V332299.R01.S.doc Version 5.2 Page 11 The third set of care records seen were those of a person who had complex physical health care problems. New care plans had been devised for this person but not all of them had been completed. The previous care plans had been taken off the person’s file so in some cases, there was no information to tell staff how they should care for this person. The daily records about the person’s health and welfare mentioned that the person had a pressure sore. Although a body map had been completed to show where the sore was, there was no record of how large or bad it was, and there was no care plan of how of what care staff should provide. All the people living at the home are registered with a general practitioner and have access to the facilities of the NHS. Records of visits made by the doctors and other healthcare professionals such as nurses were kept in the care records. The management of medicines was checked on three of the four units. There was an individual medicine administration record (MAR) sheet for each completed for each person to show they had been given their medicines as prescribed. These sheets were correctly completed and a random sample of medicines was checked and found to be correct. Medicines subject to stricter control measures were stored appropriately, and full records were maintained of their administration. People living at the home said the staff were kind and supportive. They also said they were treated with respect, and that their dignity was maintained when receiving care. The relative of one person living at the home filled in a CSCI comment card and said they had seen ‘nothing but the greatest respect shown by the staff’. DS0000018743.V332299.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. There are plenty of activities available for people living at the home so they can keep active and stimulated. EVIDENCE: The programme of activities was on display at the home and included such events as musical sessions, hand and nail care, a film show and a trip out. One of the people living at the home said that ‘extra effort is made for special occasions such as Christmas and Easter’. The activities organiser keeps an album of photographs taken at social events and makes these available to anyone who wants to see them. People living at the home had made Easter cards recently some of which were on show around the home. On the first day of the inspection visit a group of people had gone out to another home owned by the company to join in the entertainment there. The activities organiser said Winsford Grange would host a similar event in May and people from the other home would come to join in. DS0000018743.V332299.R01.S.doc Version 5.2 Page 13 Newspapers are saved over the year, and the activities organiser uses them to carry out reminiscence sessions with people. One person said that because of their condition they are unable to take part fully in the activities provided. They said that they enjoy quizzes and crosswords and that the activities organiser spends time with them helping them to enjoy these pastimes. Visitors can come to the home at any reasonable time and those who were there at the time of this inspection visit said that the staff are welcoming and friendly. They confirmed that they are kept informed of any significant changes in their relative’s condition. A Church of England minister visits the home weekly, and a Eucharistic minister from a local Roman Catholic church also visits weekly bringing communion to those people who wish to take it. People spoken with said that they are able to make choices about what they do each day. The care records have a section in them to show people’s preferences about who cares for them. People spoken with were complimentary about the standard and variety of the food provided, and one person added that this has improved recently. Choice is offered at all meals. One person commented that if they did not like either of the alternatives offered, another choice would be made available for them. Lunch on the first day of inspection was a choice between braised steak, mashed potatoes and cabbage, or shepherds pie. The pudding was apple sponge and custard, fresh fruit salad, yoghurt or ice cream. A list of people with food allergies and what these are was on display in the kitchen. DS0000018743.V332299.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints are responded to appropriately, giving confidence to people that their concerns will be dealt with. EVIDENCE: The home keeps a record of complaints received that showed that two complaints had bee made since the last inspection. The record contained details of the complaints and the responses made. Both complaints had been responded to within twenty-eight days of being received and identified the results of the investigations carried out. A copy of the home’s complaints procedure was on display in the reception area, and in the bedrooms. A copy of the home’s procedure for protecting vulnerable adults and the Department of Health’s document ‘No Secrets’ (this contains information on the different types of abuse and what to do if staff see or suspect it is happening) is available for staff to read, along with a whistle blowing policy. Staff spoken with showed a sound awareness of their role and responsibilities in protecting people living at the home. DS0000018743.V332299.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22 24 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is well maintained so people live in comfortable and homely surroundings. However, improvements need to be made to the standard of hygiene to prevent cross infection occurring. EVIDENCE: The home employs a maintenance person for 22.5 hours per week who is responsible for the routine maintenance of the home and redecoration of rooms as required. Staff on the units said that all bedrooms are redecorated as they become vacant before new residents move into them. Each unit has a choice of areas for people to sit in and a separate dining room. Each unit also has its own secure and private garden that has been well looked after. There is a patio in each garden and people were seen sitting outside. DS0000018743.V332299.R01.S.doc Version 5.2 Page 16 Grab rails were in place near to the toilets and mobile hoists were available on all of the units for people who are unable to walk unaided. Pressure relieving mattresses were used on the beds of people assessed as being at risk of developing a pressure sore. Adjustable height beds were in place for people who were confined to bed. A number of bedrooms were visited on all of the units and were seen to be comfortably furnished and personalised by the person occupying the room. One person said that they had been provided with a new chair that was more comfortable and suited their needs better than the one they previously had in their room. All parts of the home were visited at this inspection and found to be clean, tidy and free from unpleasant smells. There is only one sluice machine at the home that can be used for disinfecting commode pots. It is on Bronte Unit, and a recommendation was made at the last inspection that consideration should be given to installing a sluice machine in each unit. The facilities on the other units for cleaning/disinfecting commode pots were checked during this visit. There were no cleaning agents for ensuring that commode pots were thoroughly cleaned in any of the cleaning areas, and staff spoken with gave different views as to how this was achieved. Some said that they ask for appropriate cleaning agents from the domestic staff whilst other said that these pots are just rinsed under running water in the sluice rooms and that a toilet brush is used to remove stubborn stains. If more than one commode pot is being cleaned at any one time, it is possible that they could be taken back to the wrong room. If this happened and the pots had not been adequately cleaned/disinfected there could be an increased risk of cross infection occurring. DS0000018743.V332299.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are enough staff on duty so people living in the home get the care they need when they need it. Staff have had training to help them develop their skills and provide safe care. EVIDENCE: Staffing rotas seen showed that there are enough staff on duty to meet the needs of people living at the home. Trained nurses are required to maintain their nursing registration with the Nursing and Midwifery Council, and records were seen to show these were up to date. Forty-eight care staff are employed at the home. Twenty-three of them have achieved at least an NVQ level 2 in care. Seven other members of the care staff are currently undertaking training leading to this qualification. Four of the staff are accredited NVQ assessors, and five are safe moving and handling trainers. The personnel files of two members of staff who had started working at the home since the last inspection were checked. Both of these contained the necessary information and checks to show they had been properly checked before they started working in the home. DS0000018743.V332299.R01.S.doc Version 5.2 Page 18 One of the trained nurses employed at the home has been designated as the training and developing co-ordinator for staff employed at the home and has been given fifteen hours supernumerary each week to carry out this role. This nurse told the inspector of the various training the staff have and are due to undertake; this included: • Managing challenging behaviour • Communication • Care of the Dying • Catheterisation • Diabetes • Infection Control DS0000018743.V332299.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an experienced manager so that it is well run in the best interests of people living and working there. EVIDENCE: The manager is a trained nurse and has been in post for a number of years. There is also an assistant manager who has fifteen hours a week supernumerary time allocated to carry out management tasks. People living at the home and staff spoken with said that they were happy with the way the home was run and that they felt free to approach the manager with any concerns they might have. DS0000018743.V332299.R01.S.doc Version 5.2 Page 20 The company that owns the home carried out a quality monitoring programme last year but there has been no indication that this is to be repeated. The manager is considering introducing a satisfaction survey within the home. A manager from one of the other homes owned by the company carries out a monthly unannounced visit at the home when they review care and general records, speak with people living at the home and tour the premises. A report from these visits is made and a copy of the report is available at the home. Staff spoken with said that regular meetings are held on three of the units but not on the fourth. When this was discussed with the manager he said that he would deal with this to make sure that such meetings would take place. Small amounts of money are left at the home by families for their relatives to buy personal items. A separate account is maintained for each person, and records were seen of receipts being obtained for purchases made. The home’s administrator checks the balance for each person on a weekly basis, and when this was checked by the inspector these were found to be correct. The care records of four people that have bed rails fitted to their beds were reviewed. These contained a risk assessment about the use of this equipment that gave instructions to the staff about how they should be fitted and used. A call system is provided in all areas of the home for people to call for help. This was tested, found to be working properly and responded to promptly by a member of staff. A new fire alarm system was installed at the home in January this year. There have been various problems since then which have been attended to. The last test of the system showed that two of the bedroom doors that are wired into the system were not closing when the fire alarms were activated. The home manager said that he is contacting the engineers to report this and that he will confirm that this has been attended to. Other maintenance and equipment records were seen all of which were current and satisfactory. DS0000018743.V332299.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 3 X 3 X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 3 DS0000018743.V332299.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(1) Timescale for action Care plans must be devised and 30/04/07 put in place to address all of the identified needs of the people living at the home to ensure that they receive all the care they need. A system for ensuring that all 30/04/07 equipment used by people living at the home is thoroughly cleaned/disinfected must be implemented to reduce the risk of cross infection occurring. Requirement 2 OP26 13(3) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000018743.V332299.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000018743.V332299.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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